Military-civilian collaboration in trauma care and the senior visiting surgeon program.

On June 14, 2006, the Institute of Medicine released a three-part report on the future of emergency care, underscoring the evolving crisis in access to urgent medical care in the United States.1 The clear threat of future terrorist activity and recent experience with natural disasters highlight the need to develop a comprehensive response system based on the integration of civilian and military resources.2-5 Collaboration between civilian and military surgeons during times of war is evident throughout our history, and civilian surgeons have provided surgical care to the wounded since the Revolutionary War. Many observations during times of intense conflict translated into advances in civilian medicine.6,7 Critical analysis by military and civilian sources after the first Gulf War (1991) brought about several fundamental changes in the operation and structure of military medical units.8,9 A 1998 General Accounting Office report identified the lack of valid training in trauma care for military medical personnel, who practiced largely in military treatment facilities caring primarily for healthy, activeduty personnel and their dependents or retirees.10-12 The report recommended the development of collaborative military and civilian training platforms at urban level 1 trauma centers. In response to this mandate, the Joint Trauma Training Center was established at Ben Taub General Hospital in Houston in 1999 for military trauma teams,13-16 and the Department of Defense subsequently opened six additional trauma training sites. These programs have exposed military surgeons to cutting-edge civilian concepts in trauma care (including damage-control surgery, the use of recombinant activated factor VII [rFVIIa], and the trauma-systems approach to care). In addition, these programs have facilitated a dialogue between military and civilian trauma surgeons and are helping to improve clinical outcomes in the ongoing wars in Iraq and Afghanistan.17,18 The Senior Visiting Surgeon Program has been developed and implemented by the American Association for the Surgery of Trauma in conjunction with the American College of Surgeons Committee on Trauma (ACS-COT). The global objective of this program is to establish scientific exchange during 2-to-4-week tours at the Landstuhl Regional Medical Center in Landstuhl, Germany, between the leaders in civilian trauma care in the United States and experienced military clinicians. This program allows civilian trauma surgeons to participate in the care of injured soldiers by performing surgical procedures and directing intensive care; they also contribute to education at the center through lectures, serve as scientific mentors, and provide expert commentary during performance-improvement activities.